Stopping the Vicious Cycle: Equitable Enforcement Strategies to Achieve Safe, Stable, and Accessible Housing for People with Disabilities.

Policy Points People with disabilities experience a vicious cycle of poverty, poor health, and marginalization partly because of the inequitable implementation and enforcement of laws, including underenforcement of civil rights and housing laws and overenforcement of punitive nuisance and criminal laws. Inequitable enforcement reflects policy choices that prioritize powerful entities (e.g., landlords, developers) to the detriment of people who experience intersectional structural discrimination based on, for example, race, disability, and income. Equitable enforcement, a process of ensuring compliance with the law while considering and minimizing harms to marginalized people, can promote health and disability justice by increasing access to safe, stable, and accessible housing.

Trends Over Time and Jurisdiction Variability in Supplemental Security Income and State Supplementary Payment Programs for Children With Disabilities.

CONTEXT: Nearly 1.2 million children with disabilities received federally administered Supplemental Security Income (SSI) payments in 2017. Based on a robust review of research and evaluation evidence and microsimulations, The National Academies of Sciences, Engineering, and Medicine committee identified modifications to SSI (ie, increasing the federal SSI benefit maximum by one-third or two-thirds) as 1 of 10 strategies that could reduce the US child poverty rate, improving child health and well-being on a population level. OBJECTIVE: Describing the availability and amount of SSI and State Supplementary Payment (SSP) program benefits to support families of children with disabilities may be a first step toward evaluating The National Academies of Sciences, Engineering, and Medicine-proposed modification to SSI as a potential poverty alleviation and health improvement tool for children with disabilities and their families. DESIGN: We used public health law research methods to characterize the laws (statutes and state agency regulations) governing the federal SSI program and SSP programs in the 50 states and District of Columbia from January 1, 1996, through November 1, 2018. RESULTS: The number of jurisdictions offering supplementary payments (SSP) was relatively stable between 1996 and 2018. In 2018, 23 US jurisdictions legally mandated that SSP programs were available for children. Among the states with SSP payment amounts in their codified laws, SSP monthly benefit amounts ranged from $8 to $64.35 in 1996 and $3.13 to $60.43 in 2018. CONCLUSION: Our initial exploration of SSI-related policies as a tool for improving the economic stability of children with disabilities and their families suggests that current SSPs, in combination with SSI, would not rise to the level of SSI increases proposed by The National Academies of Sciences, Engineering, and Medicine. Understanding more about how SSI and SSP reach children and work in combination with other federal and state income security programs may help identify policies and strategies that better support children with disabilities in low-income households.

Inequity in California's Smokefree Workplace Laws: A Legal Epidemiologic Analysis of Loophole Closures.

INTRODUCTION: California's landmark 1994 Smokefree Workplace Act contained numerous exemptions, or loopholes, believed to contribute to inequities in smokefree air protections among low-income communities and communities of color (e.g., permitting smoking in warehouses, hotel common areas). Cities/counties were not prevented from adopting stronger laws. This study coded municipal laws and state law changes (in 2015-2016) for loophole closures and determined their effects in reducing inequities in smokefree workplace protections. METHODS: Public health attorneys reviewed current laws for 536 of California's 539 cities and counties from January 2017 to May 2018 and coded for 19 loophole closures identified from legislative actions (inter-rater reliability, 87%). The local policy data were linked with population demographics from intercensal estimates (2012-2016) and adult smoking prevalence (2014). The analyses were cross-sectional and conducted in February-June 2019. RESULTS: Between 1994 and 2018, jurisdictions closed 6.09 loopholes on average (SD=5.28). Urban jurisdictions closed more loopholes than rural jurisdictions (mean=6.40 vs 3.94, p<0.001), and loophole closure scores correlated positively with population size, median household income, and percentage white, non-Hispanic residents (p<0.001 for all). Population demographics and the loophole closure score explained 43% of the variance in jurisdictions' adult smoking prevalence. State law changes in 2015-2016 increased loophole closure scores and decreased jurisdiction variation (mean=9.74, SD=3.56); closed more loopholes in rural versus urban jurisdictions (meangain=4.44 vs 3.72, p=0.002); and in less populated, less affluent jurisdictions, with greater racial/ethnic diversity, and higher smoking prevalence (p<0.001 for all). CONCLUSIONS: Although jurisdictions made important progress in closing loopholes in smokefree air law, state law changes achieved greater reductions in inequities in policy coverage.